TREATMENT OF BRAIN METASTASES IN PATIENTS WITH TESTICULAR CANCER

Purpose: Despite improved cure rates for patients with metastatic test icular cancer with cisplatin-based combination chemotherapy, patients who develop brain metastases are generally considered to possess a poo r prognosis, This report summarizes the long-term results in 44 patien ts with brain metastases from testicular cancer treated between 1978 a nd 1995 at Hannover University Medical School. Patients and Methods: H istologically, 42 patients (95%) had a nonseminomatous germ cell cance r and two patients (5%) a seminoma. Thirty-nine patients (89%) had lun g metastases and 37 (84%) fulfilled the criteria for advanced disease according to the Indiana University classification even without consid ering the brain metastases. Eighteen patients (41%) presented with bra in metastases at primary diagnosis (group 1), four (9%) developed brai n metastases at relapse after a previous favorable response to combina tion chemotherapy (group 2), and 22 (50%) developed brain metastases d uring or directly after cisplatin-based chemotherapy. Chemotherapy con sisted of cisplatin-based combination treatment and radiotherapy was g iven as whole-brain irradiation of 30 to 40 Gy and in single cases com bined with a boost of 10 Gy to single lesions. Results: Overall, 10 pa tients achieved long-term survival (23%; 95% confidence interval [CI], 10.1% to 35.4%), The prognosis was significantly better for patients in groups 1 and 2, with six of 18 (33%) and three of four (75%) patien ts alive, compared with only one of 22 (5%) in group 3 (P < .01). Pati ents treated with either chemotherapy or radiotherapy alone did not ac hieve long-term survival, while nine of 28 (32%) who received treatmen t with both modalities with or without surgery achieved sustained long -term survival, During univariate analysis, patients with the diagnosi s of brain metastases at first presentation (P < .01), patients with a single brain lesion (P < .02), and patients who received combined che motherapy and radiotherapy (P < .03) had a significantly improved outc ome. Conclusion: Long-term survival can be achieved in approximately 2 5% of patients with brain metastases from testicular cancer by combine d treatment with brain irradiation and aggressive cisplatin-based chem otherapy. Patients who develop brain metastases during systemic treatm ent should receive only palliative radiation therapy, since sustained survival will not be reached. (C) 1997 by American Society of Clinical Oncology.